Time to tackle cervical cancer head-on

Cervical cancer is a cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.

According to the Centres for Disease Control and Prevention (CDC), majority of cervical cancer cases (9I per cent) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.

Most infections with HPV resolve spontaneously and cause no symptoms. However, for some women who go on to have persistent infection, it can cause cervical cancer.

Cervical cancer
Cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570,000 women were diagnosed with cervical cancer worldwide and about 311,000 women died from the disease.
In Ghana, the Global cancer observatory reported that cervical cancer ranked third highest in incidence of all cancers in 2020 and among female cancers alone recorded the second highest number of new cases after breast cancer.
The 2021 HPV related cancer fact sheet by ICO/IARC (Catalan Institute of Oncology/International Agency for Research on Cancer) estimated that every year 2,797 women in Ghana are diagnosed with cervical cancer and 1,699 die from the disease. In Ghana, however, of 348 women diagnosed with cervical cancer, nearly 60 per cent of them tested positive for HPV type 16 and 18 which cause an invasive form of cervical cancer.
The mortality among women with cervical cancer in Ghana continues to be high; 26 in 100,000 women compared to women in most developed countries: four in 100,000.
This is because of several factors, both mediated by patients as well as the health system. Late diagnosis continues to be a major concern for almost all cancers, including cervical cancer and 90 per cent of the global mortality of cervical cancer in 2018 all occurred in low- and middle-income countries like Ghana.

Global strategy

This growing public health concern brought a call to action in August 2020 by the World Health Assembly, where Global Strategy for Cervical Cancer Elimination was adopted.

The 90-70-90 target by 2030.

• Vaccination: 90 per cent of girls fully vaccinated with the HPV vaccine by the age of 15.

• Screening: 70 per cent of women screened using a high-performance test by the age of 35, and again by the age of 45.

• Treatment: 90 per cent of women with pre-cancer treated and 90 per cent of women with invasive cancer managed.

There has been a commitment by member states to achieve this target. However, for Ghana, it could be best described as a renewed commitment as there is already in existence a cancer control strategy launched in 2015 which was highly commended by WHO.

The Ghana National cancer control strategy similarly highlighted the WHO three key areas as target for cervical cancer control especially as it is uniquely among a few cancers that can be prevented by vaccination.

Like many well thought out national strategic plans, implementation of the cervical cancer strategy as launched in 2015 hasn’t been particularly effective if at all implemented.

The strategy documented in the Ghana National Cancer Control Plan was divided into three main sections, namely prevention, screening and early detection and treatment.

The prevention strategy would offer routine vaccination with one approved HPV vaccine for all females from 10 to 14 years of age as part of the national immunisation programme and funded by the health care system.

Vaccines

The vaccines would be school-based delivery to reach girls in school and community-based and outreach clinics to reach target girls who may not be in school. For those who may have missed the vaccination, a catch-up immunisation would be provided for girls aged 15-18 years.

Community-based immunisation will be provided routinely through the existing Expanded Programme for immunisation (EPI)

The screening and early detection strategy included cervical cancer awareness programme using health communication messages via posters, leaflets, and electronic media

One of the major angsts with most cancers is the fact that there are many risk factors and no known specific cause.

With cervical cancer, there is a high degree of certainty that HPV is implicated in almost all cases, and this allows women some degree of control by taking preventive measures, especially where vaccination is of high protective value.

The strategy as explained above seems like a robust plan which if implemented would protect the next generation from cervical cancer and reduce the mortality and morbidity associated with cervical cancer drastically.
HPV vaccination, screening for and treating precancerous lesions is effective at preventing most cervical cancer cases.

With early detection and effective management, cervical cancer is one of the most successfully treatable and curable forms of cancer.

Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care.

Index

It is crucial that any disease that threatens the wellbeing and life expectancy of women in the Ghanaian society be prioritised for several reasons; African Gender Equality Index reported that Women are more economically active in Africa than anywhere else in the world.

This is no different in Ghana where nearly 70 per cent of women participate in the Ghanaian economy, most importantly the agricultural sector, with women contributing to about 49.5 per cent of the total volume of food production in the country.

The Ghanaian woman is a key contributor to the economy, and most importantly to the society as far as birthing and nurturing future leaders and generation is concerned.

The current government has been a strong advocate and contributor to gender equality and women issues.

Women can only continue to be productive and contribute to nation building when they have the necessary resources, opportunities, protections and skills to achieve their full potential, and this can only be achieved in good health.

Cervical cancer has been a menace to Ghanaian women for far too long.

It is time to outdoor the cupboard-ridden but rather robust cancer control strategy and implement the cervical cancer strategy to protect the future of Ghanaian women and prolong the life of those already affected.

This will not only protect women health but also keep us in step with other developed nations and help us achieve the WHO 90-70-90 target by 2030.

The authors are lady Pharmacist' Association of Ghana (LAPAG) cancer committee member, and Chairperson of LAPAG respectively.